Sept. 9, 2009

Helping people 'notice and respond' is goal of mental health awareness efforts

Tim Marchell
Jason Koski/University Photography
Tim Marchell, director of mental health initiatives, leads discussion during a "Notice and Respond" workshop on how to recognize mentally distressed individuals.

In Psychology 101, students learn about the bystander effect -- when individuals in a crowd fail to call 911 in an emergency because everyone assumes someone else will, or no one wants the responsibility.

Mental health experts know that same phenomenon can play out when a person shows signs of mental distress.

A new set of efforts is under way at Cornell to better arm faculty, staff, students and parents with the skills to recognize a person in distress, and to know what to do about it. These efforts include a new handbook for faculty, as well as an educational program called "Notice and Respond" that uses theater to teach recognition of a depressed, suicidal or simply overstressed student.

In order to move from being "a bystander to an active agent," said Tim Marchell, director of mental health initiatives at Cornell's Gannett Health Services, "people need to notice what's going on, interpret it as a problem, feel responsibility, know what to do and overcome barriers to acting."

Although the educational materials focus on a student in distress, the themes are universal, said Catherine Thrasher-Carroll, mental health promotion coordinator.

"The information and skills are transferable to anyone who might be wanting to help someone experiencing distress," she said.

cover of faculty handbook
Provided/Dean of Students
The cover of a new faculty handbook on responding to students in distress.

Faculty handbook

Overseen by Assistant Dean of Students Casey Carr, the handbook, called "Recognizing and Responding to Students in Distress," has been funded by a gift from Catherine Taylor '67. It includes common behavioral or physical indicators of depression or suicide risk, and phone numbers for mental health and other services around campus. Similar materials are also being developed for staff, students and parents.

The book describes potential signs of mental health problems. For example: a faculty member might be puzzled by a normally conscientious student's sudden deterioration of work quality; a series of missed appointments; or a change in physical appearance. All of these things might point to a student in crisis, and people need to be able to recognize them -- even if the response is as simple as making a phone call or helping the student connect with a counselor.

"We really honor whatever a faculty member chooses in terms of the depth of their interaction," said Carr, who interviewed close to 30 faculty members while developing the materials.

Student volunteers from the Cornell Commitment and Cornell Minds Matter, a campus group that promotes student' mental and emotional health, will hand-deliver the books to all faculty in coming weeks. The students will be trained on briefly explaining the book's purpose, a personal touch that Carr said is meant to set a tone for the individual connections between students and faculty that promote student well-being.

still from video
Cornell Interactive Theater Ensemble and Media Production Group
A scene from the DVD "Notice and Respond," which is part of a workshop that teaches recognition of a mentally distressed person. The actor is Allison Buck '09, who plays a troubled student.

'Notice and Respond'

In a related initiative, Gannett staff are leading sessions with staff and faculty groups called "Notice and Respond," which include the screening of an eponymous DVD produced by the Cornell Interactive Theater Ensemble (CITE) and the former Media Production Group, and funded by a $25,000 Triad Foundation grant. They are also training staff volunteers from across campus to become "Notice and Respond" facilitators.

During the two-hour workshops, a facilitator leads discussion following the DVD and provides information on signs of distress, and how to help students connect with campus support resources.

Building on past efforts

These new efforts build on mental health initiatives that were launched in 2004 by then-Provost Biddy Martin and Vice President for Student and Academic Services Susan Murphy, who together started the Council on Mental Health and Welfare. Marchell notes that Cornell continues to offer many support services for students, including academic advising offices in the colleges, such peer programs as the Dean of Students' Empathy, Assistance and Referral Service (EARS), and Gannett Health Services' Counseling and Psychological Services (CAPS). Faculty and staff can access the Faculty and Staff Assistance Program, formerly known as the Employee Assistance Program.

"Clinical services are necessary, but they are not sufficient," Marchell said. "We need a comprehensive, campuswide network of support, and we've been building it for a number of years."

The theme of both the handbook and "Notice and Respond" -- that anyone can be active in supporting others in need -- is modeled after a highly successful suicide prevention program used by the U.S. Air Force during the 1990s. Cornell's program takes key elements of the Air Force effort and adapts them to include the entire spectrum of mental health awareness, not just suicide risk, Marchell said.

Cornell has undertaken other steps in support of student mental health. In June 2008, the university changed the way it interprets the Family Educational Rights and Privacy Act (FERPA) in order to allow disclosure of academic records to parents in certain cases.

"Notice and Respond" and the handbook are meant to address a continuum of mental health issues, Marchell said -- from someone who might be feeling overwhelmed by academic pressure, to one with a diagnosable mental illness, such as major depression or bipolar disorder.

Dean of Students Kent Hubbell said perhaps the new initiatives will not only bolster support for mental health, but also reduce the stigmatization of the most severe mental health problems.

"Maybe we will get to a place where mental health issues are considered in the same way as any other human affliction," Hubbell said.

The DVD "Notice and Respond" is a realistic depiction of a faculty member who kindly -- and at first, awkwardly -- interacts with a visibly upset student.

Written and acted by the Cornell Interactive Theater Ensemble (CITE), the DVD is a new tool that mental health staff members are now using to help spread awareness of mental health on campus.

The DVD stars Allison Buck '09, who plays a student exhibiting signs of distress. The adults around her, played by CITE administrative director Dane Cruz and adjunct actor Jacque Tara Washington, demonstrate different ways to support the student.

Designed to spark discussion in a workshop setting, the film was created as part of a broad effort to help faculty, staff, students and parents better recognize such problems as depression or suicide risk, and to know what to do.

"This program explores how to have a challenging conversation with someone who is experiencing emotional difficulties," said Tim Marchell, director of Cornell mental health initiatives at Gannett Health Services. "It is basic skill building for the non mental-health professional."

CITE, part of the Office of Human Resources, has been creating interactive theater exercises since 1992 on such issues as diversity and sexual harassment. It aims to create realistic depictions of events and then engage the audience in frank discussions. In "Notice and Respond," the goal is to help viewers recognize that everyone has a potential role to play in recognizing and assisting someone in mental distress.

"It is compelling because you see someone else experience something you can see yourself engaged in," Cruz said.

To write the script, the late CITE Artistic Director Martha Dewey spent hours last year interviewing mental health professionals, administrators, department chairs, students and staff. The final product shows the faculty member taking constructive action to help the distressed student. But it's only one of many different scenarios that could play out in real life with students, colleagues or friends.

"Our model will not answer everything," Dewey said. "It will unearth deeper questions."

Marchell underscored the central role Dewey played in the success of the program. "The positive response that we've received is a tribute to Martha's extraordinary gifts. It's part of her remarkable legacy to Cornell," he said.

As part of Cornell's approach to supporting students in distress, the university has modified its interpretation of the Family Educational Rights and Privacy Act (FERPA) to facilitate communication with parents about students' academic problems. The change coincides with mental health awareness efforts to help faculty, staff and others better recognize distressed or suicidal individuals.

When a student is struggling emotionally, grades and interest in school can be among the first things to suffer, explained Kent Hubbell, dean of students.

"We've relaxed our rule to the extent that it permits us to communicate with parents when we believe it is in the best interest of the student," Hubbell said, noting that this has made Cornell more like its peer institutions. Before June 2008, Cornell required a student's written consent to disclose academic records to parents.

Tim Marchell, director of mental health initiatives, said that the reinterpretation will allow action in "exceptional situations" and may help prevent tragedies.

"We believe we've found a good balance between respecting students' privacy and affording ourselves the flexibility to engage parents to support students in a crisis," Marchell said.

This change was spurred in part by incidents in which parents were unaware of serious academic problems that reflected underlying mental health problems. In one case, a student had fallen so far behind academically that, after four years, he had amassed only two years of credits -- and the parents never knew about it. Such cases underscore the potential importance of sharing academic information with parents, Hubbell said.

The university's policy on FERPA interpretation can be found in the Courses of Study under General Information.